Long Term Stability of Condylectomy and Costochondral Graft Reconstruction for Treatment of Idiopathic Condylar Resorption

Publication date: Available online 18 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Zachary S. Peacock, Cameron C.Y. Lee, Maria J. Troulis, Leonard B. Kaban

Abstract

Purpose

To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR).

Methods

This is a continuation of a retrospective cohort study of patients with active ICR who underwent bilateral condylectomies and CCG reconstruction from 1999-2016. Predictor variables were demographic and operative factors. Primary outcome variable was occlusal stability, as defined by normal overbite(1-4 mm) at latest follow-up. Overbite, overjet, SNB, mandibular plane angle, and ramus/condyle unit height were measured. Time points were: preoperative(T₀), immediate(T₁), 1(T₂), 2(T₃), 3-5(T₄), and 5+ years(T₅) postoperative. Descriptive and bivariate statistics were computed. A Firth logistic regression model was utilized to identify variables associated with occlusal instability.

Results

A total of 26 subjects (25 female, mean age 23.1 years) who underwent bilateral endoscopic condylectomies and CCGs were included: 14 from the original cohort and 12 additional for the current analysis. The median follow-up was 3.65 years(range 1.11-17.1). Preoperatively, all subjects had Class II malocclusion with mean overjet of 6.89mm(range 1.2-17.1) and mean anterior open bite of -2.12 mm(range -0.4 to -7.9). Normal overbite(1-4mm) and overjet(2-4mm) was achieved postoperatively in all subjects. There were no significant changes in overjet, overbite, SNB, mandibular plane angle, and ramus/condyle unit height between T₁-T₄. At latest follow-up, 88.5% of subjects had a normal overbite. Three subjects developed an anterior open bite postoperatively, one at 2 years(0.1 mm; pre-op -3.4) one at 9 years(-0.8 mm; pre-op -7.9), one at 11 years postoperatively (-1.3 mm; pre-op -1.1). In subjects with more than 5-year follow-up (T₅, n=9/26), the mean overjet and overbite were 3.48 and 1.56, respectively. Non-white race and follow-up time were significant predictors of occlusal instability in the regression model.

Conclusion

Stable and predictable long-term outcomes can be achieved using endoscopic condylectomy and CCG reconstruction for treatment of active ICR.

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